Insulin pumps and continuous glucose monitors have come a long way, making at-home diabetes care easier.
Your lifestyle, how much insulin you need and how comfortable you are with technology will determine which device is right for you. Include your health care provider and family in the conversation.
It's important to maintain the devices. Follow your provider's instructions, and don't ignore error messages.
At-home technology for diabetes continues to evolve, giving people more peace of mind that the disease is in check while they enjoy their day. But how do you know you have the right device for your health and lifestyle? Jennifer Adcock, RN, BSN, CDCES, a certified diabetes care and education specialist at OSF HealthCare, has a roadmap. She says there are two main categories:
Insulin pumps: These deliver insulin into your body to mimic the body’s natural production. This helps keep blood sugar at a healthy level. Adcock says it looks like a cell phone clipped to your midsection.
“We have tubeless ones or ones with tubes. You would choose what works best for you,” Adcock says. “Some people are too active to be connected to that tube. So they would choose something like an Omnipod, which is a brand of tubeless insulin pump.”
How much insulin you need daily also plays a role in which device you choose, Adcock says, because some hold more insulin than others.
Continuous glucose monitors (CGMs): It’s a patch on your arm with a filament under the skin. It reads your glucose every few minutes, and the results are transmitted via Bluetooth to a receiver or cellphone. This can let you know in real time if your blood sugar is too high or too low, and you can take quick action to avoid a serious health issue.
“It’s a big improvement,” from the old way of pricking yourself throughout the day, Adcock says. The con, though, is that the device can be expensive if your insurance doesn’t cover it.
Decisions, decisions
Deciding which diabetes device to use should start with a talk with your health care team and loved ones. Beyond that, lifestyle choices might come into play. Do you not want to carry insulin shots with you all the time? A pump might be the way to go. Or conversely, do you struggle with technology and don’t have someone at the ready to help? Maybe a CGM isn’t the choice for you, and you use the old finger-prick method.
“Make sure you’re not afraid to ask questions of your health care providers. That’s what we’re here for: to help,” Adcock says.
Daily maintenance
Regardless of what you choose, it’s important to keep the devices working properly. If, for example, your CGM stops working unbeknownst to you, your blood sugar could spike or drop, and you could wind up in the hospital. So talk to your health care provider about a backup plan if your primary device fails.
“Make sure you’re using your device correctly and as ordered by your physician,” Adcock implores. “These devices will give you messages like ‘It’s time to change your pump site’ or ‘It’s time to change your CGM site.’ Make sure you’re not ignoring and avoiding those.
“A really neat feature of CGMs is that since they use Bluetooth, you can have a support person also connected. They can review your numbers in real time but not be in the same area,” Adcock adds.
Brittle diabetes is a severe and unpredictable form of diabetes that makes blood sugar control extremely challenging. Endocrinologist explains its causes, symptoms and modern treatment options
For most people living with diabetes, managing blood sugar is about routine, eating right, taking insulin or medicines on time, and staying active. But for some, blood sugar levels refuse to cooperate despite doing everything by the book. This condition is known as brittle diabetes, or labile diabetes, and it can make everyday life exhausting and unpredictable. Though not an official medical diagnosis, brittle diabetes is a term doctors use to describe diabetes that is extremely difficult to control. It is characterised by sudden and frequent fluctuations between very high and dangerously low blood glucose levels.
Endocrinologist and diabetologist Dr Piyush Lodha tells Health Shots that these fluctuations can significantly affect quality of life, often leading to repeated hospital visits, anxiety and physical fatigue. Understanding why this happens is the first step toward better management.
Brittle diabetes causes sudden highs and lows in blood sugar. Image courtesy: Adobe Stock
What is brittle diabetes?
Brittle diabetes refers to diabetes, most commonly type 1, but sometimes type 2, that is unusually unstable. “In brittle diabetes, blood glucose levels fluctuate unpredictably, causing extreme highs and lows despite proper insulin use and lifestyle measures,” explains Dr Lodha. The term was first introduced in 1934 and has since been used to describe cases in which daily life is repeatedly disrupted by hypoglycaemia or hyperglycaemia.
Brittle diabetes is relatively rare but serious. Research published in Diabetes, Metabolic Syndrome and Obesity (2023) suggests that about 12 out of every 10,000 adults with diabetes experience this condition. While it can affect older adults, studies show it is most commonly seen in younger people aged 15 to 30 years, according to findings in the Journal of the Royal Society of Medicine.
Symptoms to watch out for
The main sign of brittle diabetes is erratic blood sugar. Low blood sugar may cause shaking, sweating, confusion, dizziness, mood changes, or even fainting and seizures in severe cases. High blood sugar, on the other hand, can lead to excessive thirst, frequent urination, fatigue, dry skin, blurry vision and nausea. These symptoms may appear suddenly and without an obvious trigger.
What are the ‘hidden’ triggers of blood sugar swings?
If you are following your plan but your numbers are still haywire, an underlying condition might be to blame:
1. Digestive tissues: Conditions like Gastroparesis (delayed stomach emptying) or Celiac disease make nutrient absorption unpredictable, causing insulin and food to mismatch in the bloodstream. 2. Hormonal surges: Stress-related hormones like cortisol and adrenaline can interfere with insulin function, causing rapid, unexpected rises in glucose. 3. Psychological stress: Severe anxiety or depression can physically alter how your body processes sugar, making mental health support a critical part of treatment.
Treatment and management options
While brittle diabetes is challenging, modern medical advances are helping patients find stability:
1. Continuous glucose monitors (CGM): These devices provide real-time data, helping to catch a swing before it becomes an emergency. 2. Insulin pumps: These allow for more precise, minute-by-minute insulin delivery compared to traditional injections. 3. Pancreas transplants: In severe, life-threatening cases, a transplant may be considered. Research in diabetes care reports high success rates in stabilising blood glucose levels with this procedure.
In addition, a consistent diet rich in whole grains, vegetables, fruits, and legumes, combined with regular physical activity, can support better glycaemic control.
You may think you need to eliminate or seriously reduce your carb intake to manage your blood sugars, but this isn't necessarily true.
While closer consideration of carb intake is typically helpful for diabetes management, it doesn't mean you can't still enjoy carbs! Protein can help offset blood sugar spikes, and some carbohydrates are also good protein sources. Learn the best high-protein carbs for blood sugar management and what to look for in a blood-sugar-friendly snack.
Ali Redmond
1. Beans
Next time you're looking for a protein source for a meatless Monday (or any day for that matter), look no further than beans (or their close cousins, other types of legumes). While their carb content may concern some folks with diabetes, their protein and fibre help offset their impact on blood sugars. "Beans have a great amount of protein in them, and bonus, they have fibre too, which also slows down digestion.
Fibre is an indigestible carbohydrate that provides many benefits, such as promoting digestive health, reducing cholesterol levels and stabilising blood sugars. Since it does wonders for your health and blood sugars, consider choosing high-fibre carbs whenever you can. These include vegetables, fruits, whole grains and legumes. For some, this can feel more satisfying, plus that blood sugar management bonus," says Ashley Munro, M.P.H., RDN, CDCES.
2. Yogurt
Dairy products, specifically milk and yogurt, are another source of carbs and protein. The carb and protein content of yogurt varies based on the type, with traditional yogurt being lower in protein and higher in carbs than strained (Greek-style) yogurt. Either way, the protein and fat content helps prevent rapid blood sugar spikes. Plus, Munro says, "Yogurt can be a fun vehicle to adding nutrients like fruit (for fibre) and nuts. Texture can impact how we enjoy foods, so that creamy-crunchy combo can be a nice experience."
Munro says, "Protein just takes longer for your body to process, so it helps slow down the journey, which can make you feel satisfied or fuller longer." In addition, research, has demonstrated a relationship between gut health and diabetes, so the probiotic boost from yogurt may amplify this food's benefits for those with diabetes.
3. Legume Pasta
With more and more food innovations lining grocery store shelves, there are new fun ways to help manage diabetes through your diet. One of these newer food inventions is legume pasta, made with protein sources like chickpeas, lentils and yellow peas rather than durum wheat. These can have around four times as much protein and half as many carbs as traditional pasta, which can help offset blood sugar spikes.
If you have diabetes, this prevents you from needing to add as much protein from other sources, like meat, when eating pasta. That being said, while you need to moderate your carb intake if you have diabetes, pasta made from grains, like wheat, rice or quinoa, can be part of a diabetes-appropriate diet.
What to Look For in a Blood-Sugar-Friendly Carb
First, it's best to lean into your preferences when picking carbs. If you ignore your cravings for the sake of health, the changes may not be sustainable, and you'll have to sacrifice satisfaction! Munro says, "Carbs should be what a person wants to eat, enjoys and makes sense from a cultural and accessibility perspective."
From there, she recommends integrating blood-sugar-friendly food combos. She says, "This could look like someone who enjoys crackers, making them blood sugar friendly by adding some protein like lunch meat and fat such as nuts," which helps promote satisfaction without spiking blood sugars like carbs alone would.
Our Expert Take
Pairing protein with carbs helps offset blood sugar spikes and promotes satisfaction. Rather than avoiding carbs, it can help to think about what you can add to your meal or snack to promote your health and help you feel good. Since everybody is different, Munro says, "It does take some trial and error to see what works the best for someone, but it can really empower them when they start to feel better!"
So, consider trying new food combinations and getting curious about how they impact your body. When managing diabetes, it's best to work with a health care provider who can provide individualized guidance and recommendations.
More often than not, ideas about who gets diabetes, how it develops and what living with it really involves are shaped more by outdated stereotypes than medical fact. That confusion matters: it can delay diagnosis, fuel stigma and make an already demanding condition harder to manage.
Here, we unpack eight of the most persistent myths about diabetes and explain what the evidence actually tells us.
Myth 1: Type 1 diabetes is caused by eating too much sugar
This is one of the most damaging myths of all. Type 1 diabetes (T1D) has nothing to do with diet or lifestyle. It is a chronic autoimmune condition that occurs when the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. Without insulin, the body cannot regulate blood glucose levels, making lifelong insulin therapy essential.
“In type 1 diabetes, the immune system mistakenly attacks the insulin-producing cells in the pancreas, resulting in the person losing the ability to produce their own insulin. Sugar or ‘junk food’ does not cause this autoimmune process,” explains endocrinologist Dr Ben Nash, who lives with type 1 diabetes.
No amount of sugar intake causes T1D. The condition develops silently over many years, often long before symptoms appear. Blaming food choices not only spreads misinformation but also places unnecessary guilt on people living with the condition.
Eating too much sugar does not lead to being diagnosed with T1D. Image: Canva
Myth 2: Type 1 diabetes only affects children
While T1D is often diagnosed in childhood, it can develop at any age. Each year, around 3,000 Australians – many of them children – are diagnosed with T1D, which is the equivalent of eight people every day. However, adults are also diagnosed, sometimes well into later life.
“Approximately 50 per cent of people with type 1 diabetes are diagnosed in adulthood, yet many still think of it as a childhood condition,” says Dr Nash.
This misconception matters. “Adults with symptoms such as weight loss, thirst, fatigue, or frequent urination are often misdiagnosed with type 2 diabetes. Delayed diagnosis can lead to serious illness, including diabetic ketoacidosis, a diabetes emergency that can be life-threatening.”
Myth 3: Diabetes always runs in families
Family history does play a role, but it is far from the whole story. Approximately 90 per cent of people diagnosed with T1D have no known family history of the condition. That means most diagnoses come as a complete shock.
Dr Nash explains: “There is a genetic component, but 9 out of 10 people with type 1 diabetes have no family history.” While certain genes are associated with increased risk, “having these genes alone is not enough to cause someone to develop type 1 diabetes.”
Instead, “it is thought that an additional environmental trigger, in addition to genetic factors work together to cause type 1 diabetes to develop.”
Myth 4: You can ‘outgrow’ type 1 diabetes
Type 1 diabetes is lifelong. Because the body permanently loses its ability to produce insulin, there is currently no cure and no way to outgrow the condition.
“Once the immune system destroys insulin-producing cells, the body cannot regenerate them,” says Dr Nash. “That’s why people with T1D must give themselves insulin every day.”
Management requires daily insulin, careful monitoring of blood glucose levels and constant decision-making, a reality that is often underestimated by those who don’t live with the condition.
Myth 5: Insulin means you’ve failed to manage diabetes properly
This myth is particularly misleading when it comes to T1D. People with type 1 diabetes need insulin to survive, full stop.
“Insulin is essential for people living with type 1 diabetes because their bodies are no longer able to produce it,” says Dr Nash. “In type 1 diabetes, insulin is simply replacing a hormone the body no longer makes.”
Without insulin, blood glucose levels rise dangerously and can quickly lead to diabetic ketoacidosis (DKA), a life-threatening complication and a leading cause of hospitalisation for people with T1D.
With the correct treatment plan, those with diabetes can lead healthy lives. Image: Canva
Myth 6: People with diabetes can’t live full, active lives
Living with diabetes is demanding, but with appropriate treatment and support, people with T1D can and do live full, active lives.
“Living well with type 1 diabetes means people can pursue careers, travel, exercise, and spend time with family without limits,” says Dr Nash. “Advances in diabetes technology has made this more possible than ever.”
However, he notes that much of the effort involved goes unseen. “The invisible work includes constant monitoring, planning ahead, carrying supplies and making decisions that most people never think about.”
Myth 7: The symptoms are always obvious
Classic symptoms such as excessive thirst, frequent urination and unexplained weight loss are well known, but they don’t always appear suddenly or clearly.
“These symptoms can develop gradually and be mistaken for stress, viral illness, menopause, or other conditions,” says Dr Nash.
If insulin is not started in time, high blood glucose levels can escalate rapidly into DKA. “Delayed diagnosis can lead to serious illness, such as diabetic ketoacidosis, a medical emergency that results from inadequate insulin levels to meet the needs of the person with diabetes.”
Myth 8: Diabetes isn’t that expensive to manage
The financial burden of type 1 diabetes in Australia is substantial and increasing. Ongoing costs include insulin, glucose monitoring supplies, medical appointments and, for many families, lost income due to reduced work capacity. These costs are lifelong, reflecting the permanent nature of the condition.
While you may be familiar with the insulin pumps and blood tests that become part and parcel with a type 1 diabetes diagnosis, you're probably less aware of the mental burden of the disease.
Know someone with type 1 diabetes? Those affected make hundreds of health decisions every day, balancing insulin, food, movement and rest in a way that many of us are unaware of.
And while type 2 diabetes is far more common, due to its link to lifestyle factors, type 1 is a different beast: an autoimmune disease, with an unknown cause, and no cure.
It's no wonder burnout, anxiety and poor sleep are so common in people with type 1 diabetes. Yet these side effects are rarely spoken of, surpassed by the physical demands of the condition.
Beyond the long-term damage and complications caused by diabetes (including permanent damage to eyesight), the toll of managing the condition can increase the likelihood of mental health issues.
Dr Ben Nash, a Melbourne-based endocrinologist and medical affairs director at Medtronic Diabetes Australia, was 17 when he was diagnosed with type 1 diabetes.
“There's a lot of cognitive burden, a lot of micro decisions that you have to make with type 1 diabetes, every day and every minute of every day,” said Nash at a recent Medtronic event. “It's essentially like having a second job – unfortunately, it's not a job you've asked for.”
Image: iStock
Describing type 1 diabetes management as “like walking a tightrope,” Nash says it requires a constant balance between blood sugar that’s too high, with long and short-term risks, and blood sugar that’s too low, which can starve the brain of glucose.
That constant balancing act carries a significant psychological cost, says psychotherapist and counsellor Rebecca Hirst. “There is a constant need for risk management, and personal responsibility for survival – a kind of vigilance that means one can never really switch off, with a nervous system on a low-level ‘threat response’ mode,” says Hirst.
“People managing chronic health conditions, especially in adulthood, have often developed very high levels of competence – adaptive coping strategies that signal ‘Everything’s fine’, when in fact, the weight of living with the condition may be becoming unmanageable,” says Hirst.
The mental load of diabetes can also fall to family members. Image: iStock
While often we focus on the medical side of chronic illness, family and friends should also be aware of a person’s felt experience, says Hirst. “We know that when someone feels alone or emotionally misunderstood in their experience, their stress and pain levels increase, and their symptoms often do too,” she says.
To better support a loved one with type 1 diabetes, acknowledge the invisible load they’re carrying, but also avoid ‘checking behaviours’, as this can undermine a person’s autonomy. Image: iStock
To better support a loved one with type 1 diabetes, acknowledge the invisible load they’re carrying, but also avoid ‘checking behaviours’, as this can undermine a person’s autonomy.
It's also crucial to do your own research. “You can help reduce the cognitive load of your loved one by learning about the condition independently, and even helping to educate others for them,” says Hirst.
There’s no ‘threshold’ of suffering that people need to reach in order to be justified in choosing to start therapy. Image: iStock
Since his diagnosis as a teen, Nash has gone on to specialise in diabetes, yet he admits he still has “a hard time with diabetes on a day-to-day basis.”
“It's not easy – it takes a whole team to help manage it,” says Nash. “There's this constant background burden you have to deal with on top of all the other important things you have to do day-to-day.”
From a mental health perspective, Hirst says there doesn’t need to be a breaking point to seek support.
“There’s no ‘threshold’ of suffering that people need to reach in order to be justified in choosing to start therapy,” she says.
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